The Origins of NPI

The beginning of NPI was like a miracle. I suppose any conception has the elements of mystery and amazement. NPI certainly did. I think in 1983 when a group got together, it was like a sperm penetrating an egg and suddenly cells grew, doubled and multiplied. Who can really say how this happened.

I am one witness and I made a contribution. If you will remember the story of the blind men describing the elephant, this attempt at telling of NPI’s beginnings is my version of what the elephant is like.

When I emerged from the womb of graduate school in 1977 I found myself practicing effectively but with little satisfaction. With whom could I share the struggles that came as part of my work? The pledge of confidentiality often left me feeling alone and isolated. I was too enmeshed with my clients and I had a limited perspective on my work.

It was about 1978 when my father gave me some important advice. My father was the head of the oldest family law firm west of the Mississippi River. Before him his father, David, was the principle attorney in that firm and before him my great grandfather practiced law in the same small town.

As I was about to enter the practice of psychology, my father said to me,

“Son I didn’t learn a damn thing about how to practice law in law school. It took three years after law school before I was ready to try a case. My father taught me how to be a lawyer and his father taught him. I had planned for you to be a lawyer and return home where I could teach you, but that’s not what’s happening. Since I can’t help you be a good psychologist, I want to give you some advice. Find the best practicing psychologist that you can and get them to teach you how to be a good one, cause I’m pretty sure school didn’t teach you that.”

I followed my father’s advice. I met with Bob Stepbach every Monday for fifteen years. He was like a father to me and I think I was like a son to him. I was not Bob’s only professional child. There were many who learned about themselves, life and the practice of psychology from Bob.

One thing about my relationship to Bob and my profession seemed terribly wrong. Though my relationship with Bob was essential to my professional well-being, our work to keep me professionally and personally balanced; our relationship got no professional recognition. I went to useless, boring workshops and got CEU’s but there was no external support for the time and money invested in my mentor, Bob. One of my ideas for NPI was that it would somehow provide CEU’s to people who worked with mentors. I hoped NPI would encourage mentoring. I hoped that NPI could transform continuing education from being boring presentations about research and theory to being individualized and small group learning. I hoped therapy for therapists would become an essential standard in our field.

Bob was a former President of the Tennessee Psychological Association. He was a Julliard trained jazz musician, he was a poet, an artist, a woodworker and a nurturer. And he was a shy, humble man. When I first came to see him, he was about fifty-two years old. He told me that he had a heart problem and that he didn’t expect to live much longer, but if I could accept that, he would be glad to take me on. He did die young but fifteen years later at age sixty-seven.

I write about this because it may explain his reluctance to use his creativity and his professional network to become the initiator and visionary that he might have been. I was one of several people to whom he was a professional father and we were his children. Early on in my work with Bob, I had this idea about an organization of therapists that might support one another and promote psychotherapy and psychological awareness.

Bob and I were both products of the Peabody Psychology department. His mentor there was Jules Seeman. Mine were Bob Newbrough, Larry Weitz and Larry Wrightsman. From our training we both got the same message. That message was that good therapy was not confined to any one profession. A good therapist was a rare person that might emerge from anywhere. They might not even be a mental health professional. Sometimes training helped people become better therapists and sometimes it didn’t.

While I was at Peabody the three professional psychology training programs merged into what became known as the Transactional Ecological Psychology program or TEP. The philosophy of the program included the notion that the lines between psychology specialties were arbitrary and had little to do with the practice of psychology and what students needed to know to perform in their chosen profession. Therefore, these programs merged into a tripartite program that allowed students admitted to one program to move from one specialty to another and to take courses in any of the specialty areas. The premise being that, at its base, the practice of psychology is the same. Psychotherapy is psychotherapy, whether conducted by a clinical, counseling or school psychologist. Or for that matter by a psychiatrist, social worker, pastoral counselor or psychiatric nurse.

This point was underscored at the time by a famous Hans Strupp study that demonstrated that untrained psychologically-minded, kind, empathetic people were just as effective as therapists as were highly trained, credentialed professionals.

One of Peabody’s training practicum sites was the Child Study Center at Peabody. There the most gifted therapist to learn from was not a psychologist, but a social worker, Jennie Adams. When I came to Peabody, Jennie had left, but her reputation remained. She was often used as an example of the fact that good psychotherapy knew no professional boundaries and was not a monopoly held by any guild.

Another influence on my desire to form NPI was my internship at the Palo Alto V.A. on the Family Study Unit. I trained working in front of one-way mirrors, always observed by a team of peers and mentors. These mentors included psychologists, social workers, psychiatrists and licensed marriage and family therapists. There Beth Richards, a psychiatrist, had what I and others thought was an exceptional clinical ear and a natural kind manner, much like Jennie Adams.

Learning as part of a team was a unique and wonderful experience that I will always cherish. When I returned to Nashville to pursue my career, I promised myself that I would find a way to continue this team learning experience. I was especially interested in using the team approach with families.

Very soon I had my opportunity. I was on the research faculty at Peabody and I had access to the Child Study Center therapy rooms with one-way mirrors and observation rooms. I had several cases that seemed appropriate for the Pallazolli team therapeutic intervention. At that time insurance companies supported this kind of intervention.

I formed teams around these cases, got permission from the families to be videotaped and observed for teaching purposes and worked with them as part of a four person team. We used a paradoxical approach. We met once a month for ten months and wrote letters to each family member after each session prescribing their symptoms. I asked Beth Richards to fly in to conduct a seminar around one of these cases. The most important thing was that this approach was effective. I still hear from these families some thirty years later about how this experience changed their families. I think a great deal of the power of this intervention came from the amount of eyes that were on the process. The audience potentiated each intervention, each word said, each sentence read. I believe that the families took their work with this team very seriously because they considered these interventions to come from a collaboration of many minds with them, the family, as the central focus.

These meetings were part of the impetus for the founding of the Nashville Family Therapy Consortium. This was a group much like NPI except that its primary focus was families. And as you know, family therapy is much less popular now and ethics concerns forbid us from doing many things we could do then with families as teaching cases. For that and other reasons the Family Therapy Consortium disintegrated.

Teaching and learning from colleagues has always seemed preferable to me, rather than learning from a hero, author, academic who came down from Mount Olympus to speak the unwashed. Learning from colleagues became even more preferable to me when I became aware of what I considered the wealth of talent and experience that existed in the world of private practice, in contrast to the academic clinicians who were often portrayed by APA as the standard bearers of our profession.

In private practice there were many therapists who saw between thirty and fifty client hours in a week. In academia it was unlikely that a clinician would have ten consultation hours of client contact a week. As I got to know my private practice colleagues, their skill set seemed far broader and deeper than the academics I met.

These were all masters at their craft. They had much more to teach me than anyone from Philadelphia or New York. And learning from them was so much more fun.

Another influence on my motivation to join in the founding of NPI was that I was a trained community psychologist. I was the author of the sense of community theory that is now cited in community psychology texts. I have always believed in the power of community. We, together, are greater than the sum of our parts.

Yet, at the same time, I hated learning in large groups. I remember as a boy in the first grade, as one of twenty-five six year olds in Mrs. Goodloe’s class, thinking that there was something terribly wrong with all of us being forced together into this room and taught the same thing, at the same time. What if I didn’t want to learn that then? What if I was interested in something else? Why can’t I learn what I want to learn, when I want to learn it? To me, then, warehousing children in a forced learning situation seemed wrong and it still does.

I had decided that I was going to do something about this. If they could gather us children all up in this building, I could go down the hall, announce that we were all leaving the building, walk two blocks over to main street Arkadelphia, Arkansas and march downtown to the courthouse. I was ready to do just that until it occurred to me that I didn’t know what to do when we got to the courthouse and I didn’t know what to do instead of school. And then it also occurred to me that the girls liked school, would mind the teachers and wouldn’t come anyway. So at noon, when the others went to lunch, I walked home. I was getting myself some milk and making a peanut butter and jelly sandwich when Mrs. Goodloe called and said, “David what are you doing at home?” I replied, “I walked home.” She answered, “Well walk back before I call your daddy.” I did and that was the end of that protest. But I have hated school everyday of my life and I have strongly felt that there was a better way to organize people around learning.

For years I had been kicking around this idea for an organization like NPI with Bob. In 1982 many things in my personal life began to unravel. As has happened often in my life, as one door shuts another opens. I began to imagine a way to hit a professional homerun. My 1982 vision seems silly to me now. I can’t imagine that it would work. I created two corporations. One was a for-profit continuing education travel seminar corporation to serve therapists. My vision was to have seminars in Jamaica, lie in the sun, smoke the local weed, practice yoga, talk dirty and talk therapy.

This vision of an about-to-be divorced man was not shared by the masses. I sent out brochures and got only one person to register for my Jamaican retreat. Another failure.

But the other non-profit corporation, the Nashville Psychotherapy Institute, everything that touched it seemed to work. Bob Stepbach suggested that I talk to Jennie Adams. We met for lunch at the Bluebird. Jennie was eager to help. I talked with Roy Hutton about the idea. He was for it. Jennie suggested we talk to Jules Seeman. We met with Jules at his home. He was for it. I went to talk to Hans Strupp. He was for it. I talked to Dick Bruehl. He was on board. Gloria Calhoun thought this was a good idea. Jim Nash too. Jennie approached Bill Fitts and got his support. Larry Hester agreed to support it.

The idea was a simple one, an organization that would bring together therapists of all disciplines. We would meet as a large group monthly for lunch once a month. We would have small cell groups that allowed for small group learning, like the family therapy consortium. The small cell groups would feed information and requests to a board. NPI would become an accredited body for awarding CEU’s to various professions represented in NPI. NPI would support the small colleague consultation groups and therapists receiving therapy with CEU’s.

NPI would support the development of the theory and the practice of psychotherapy in Nashville, Tennessee, hoping to make Nashville a center of and perhaps a model for learning.

We had two or three organizational meetings in the large meeting room at what was then called the MRL building at Peabody. Then we invited all the therapists listed in the phone book and all therapists working for agencies to a first luncheon meeting at Richland Country Club. This meeting was held in January of 1984. There were some fifty people in attendance. The cost was ten dollars for lunch.

We formed a board. Bob Stepbach and Jules Seeman served together as board co-chairs of NPI for the first two years. Board members included Gloria Calhoun, a psychiatric nurse; Bill Fitts, a psychologist; Jennie Adams, a social worker; Dick Bruehl, a pastoral counselor; Roy Hutton, a psychologist; Jim Nash, a psychiatrist; Bob Stepbach, Jules Seeman, Larry Hester, Hans Strupp and myself, psychologists. Larry dropped off the board, leaving ten board members as our first board.

Dick Bruehl agreed to develop a set of by-laws. I agreed to organize the speakers for the lunch meetings and we were off.

Hans was in charge of applying for APA certification for CEU’s. He determined that this process would be so cumbersome that it was not worth our time. We decided to award our own CEU’s and they could be used by members as they chose.

The formation of NPI was like magic. I have never been connected to anything like this. Jennie was amazing. She had a way of making people feel included and a part of things. She moved without making any waves. Bob Stepbach was always present. Any time I needed his ear or his encouragement, I had them. His was a quiet steady presence. Roy Hutton, another son of Bob’s, was a steady voice and presence. The blessing of Jules Seeman and Hans Strupp was essential. Jim Nash and Gloria Calhoun helped provide credibility in the medical professions. Dick Bruehl gave us connections to the religious communities.

The feelings of isolation and disconnection that greeted me as I began my professional life were obviously shared by many others. It was this shared disconnection that was the engine behind the founding of NPI.

Though small colleague support groups existed then and do now, NPI has yet to find a way to help in their development or to nurture them so that they can continue. As yet, NPI has formed no web of connection among these colleague learning groups. NPI was been successful in sponsoring lunches, lunch speakers and seminars. There is a mentoring breakfast every year and a list of willing mentors on NPI’s website. The first setting for our lunch events and seminars was the University Club at Vanderbilt.

After two or three years Bob and Jules suggested that the chair be passed from year to year and that terms be established for board members. Jennie Adams became the next chair. Bob and Jules rotated off the board.

Jennie and Bob shared a shyness for the spotlight. Jennie agreed to be the chair if I would act as host for the lunches. I agreed to continue in this role.

My social awkwardness and interpersonal skill deficit was not so obvious in my role of master of ceremonies. Jennie’s warmth and sensitivity to others was well used as she greeted people as they came in. She would have to remind me to welcome new members and to have guests introduce themselves. Those things never occurred to me.

During Jennie’s term she became very concerned about the number of clients that many of us were seeing who had been victims of sexual abuse by therapists. She wanted NPI to offer some help to these victims and some vehicle for therapists to reconcile with their abused client and become accountable for their behavior.

I succeeded Jennie in the role of NPI chair. Jennie pitched this hot potato of issue of therapist sex abuse to me and I caught it as best I could. NPI sponsored a group for victims of therapist sex-abuse. We organized several mediations between client and therapists. Some went well. Some didn’t.

This issue was so overwhelming that in my term I was unable to focus on what I wanted to achieve as chair. That was to organize and support the development of small learning groups within NPI. I hoped to create ties from these groups back to the NPI board. I was unable to accomplish this during my term, but we did start a newsletter, Psychobits. We were often desperate for copy so I wrote several articles in the first issues.

I remember a time when we were particularly desperate for some material for Psychobits. Judy Draper and I were members of a small colleague support group. She overheard me say that Ted Hazelton was a flake. She reprimanded me for saying such a thing and I told her that I could have said that to his face. She was still not satisfied. So I wrote an article in Psychobits about my friend and colleague, Ted. We had worked together in my Parkwest Eating Disorder Program. Ted was the psycho-dramatist for Parkwest. When I first met Ted, I wondered if he could walk across the street, so I insisted that I be his assistant in the psychodrama groups. Ted was amazing. I quickly saw that he enjoyed his role as the damsel in distress and he hid his considerable brilliance behind his façade of ineptitude. Ted enjoyed playing the fool but he was no fool. Ted is funny, very funny. He is always in a play. He has a sense of how the drama is unfolding in the lives of those he works with. Ted is indeed a brilliant amazing flake.

Our first symposium was held at the Vanderbilt Loews Hotel. Liston Mills was our speaker. Liston was editor of a pastoral care journal and the head of the Pastoral Counseling Program at Vanderbilt Divinity School. That program was well attended and we made a profit.

One of our next symposia was on cognitive behavioral therapy. Now, mind you, none of the board members were cognitive behavioral therapists. We were different versions of systems, humanistic, psychoanalytic, experiential, hypnosis, behavioral. But Cognitive Behavioral Therapy was coming onto the scene and we felt it should be introduced to the Nashville community. This event lost money. We were in the hole to the tune of $2,000 plus.

We could not cover our expenses which included an administrative assistant and cost of the speaker for the symposium. Jules took out a personal line of credit of $5,000 and we were able to continue on. Within a year or two we were in the black again.

NPI had several adventures with administrative assistants. The organization has relearned the lesson several times that an honest, attentive, administrative assistant is an essential asset to an organization such as ours. Currently NPI is blessed to have Lisa Smith in that role.

Every few years the issue of organizational boundaries arises. Dick Bruehl and Ruth Smith led us early on through this thicket of who can and who cannot belong. If it was left up to me everybody who wanted to pay dues could be a member. It’s probably a good thing it was not up to me.

I think our early position was that a member had to belong to a guild that had a code of ethics governing the practice of psychotherapy. We did not want to become an organization beset with ethics violations to manage.

We did, however, develop a voluntary Bill of Patient Rights that members might or might not choose to post in their waiting rooms. Again this came from Dick Bruehl. It was an artfully presented, well-constructed document. Many members displayed it on their office walls. It hung in my waiting room for many years. I don’t know what happened to it. I wish it was still there. If someone can find a way. I would love to have another one.

As I said earlier, Psychobits was often desperate for material. But it was a good vehicle for me and others to begin to develop confidence as writers.

I am sure others will offer different perspectives on how NPI was born. But this is one blind man’s view of the elephant. Many things have happened since my tenure on the board that others can speak to better than I.